Posts Tagged ‘respiratory distress syndrome’

If your baby is in the NICU, you know that there are a lot of people caring for her and helping her to get stronger each day. One of those NICU team members may be a respiratory therapist. A respiratory therapist (or RT) cares for babies with breathing problems.

When your baby first arrives in the NICU, a respiratory therapist evaluates her breathing. The RT looks to see if your baby is breathing too fast, if the breaths are shallow, or if she’s struggling to breathe. Then, together with the rest of the NICU team, the RT develops a treatment plan to help care for your baby.

Breathing problems: Premature babies often have breathing problems because their lungs are not fully developed. Full-term babies also can develop breathing problems due to complications of labor and delivery, birth defects and infections.

Apnea: Premature babies sometimes do not breathe regularly. A baby may take a long breath, then a short one, then pause for 5 to 10 seconds before starting to breathe normally. This is called periodic breathing. Apnea is when a baby stops breathing for more than 15 seconds. Apnea may be accompanied by a slow heart rate called bradycardia. Babies in the NICU are constantly monitored for apnea and bradycardia (often called “A’s and B’s”).

Respiratory distress syndrome (RDS): Babies born before 34 weeks of pregnancy often develop RDS. Babies with RDS do not have enough surfactant, which keeps the small air sacs in the lungs from collapsing.

Pneumonia: This lung infection is common in premature and other sick newborns. A baby’s doctors may suspect pneumonia if the baby has difficulty breathing, if her rate of breathing changes, or if the baby has an increased number of apnea episodes.

Many babies who need treatment for breathing problems benefit from respiratory therapy. In fact, neonatal respiratory therapy has become its own medical sub-specialty. A neonatal-pediatric RT is trained to use complex medical equipment to care for the smallest babies with mild to severe breathing challenges. They visit their patients daily or as often as needed and are an important part of your baby’s NICU team.

Pneumonia is an infection in the lung(s) which can make it hard to breathe. Premature infants are more prone to developing infections due to their immature immune systems. They were born before they could acquire their mother’s antibodies to fight off infection, which are usually transferred in the third trimester. In addition, due to prematurity, their lungs are not fully formed, making it easier to develop infections such as pneumonia.

Causes and treatments

Pneumonia can have different causes: viral, bacterial or even fungal. It can be hard for doctors to diagnose pneumonia, as it can look like other common preemie disorders, (eg. Respiratory Distress Syndrome). In addition, it may take some time for blood, urine or other lab tests to confirm the diagnosis. Therefore, as soon as pneumonia is suspected, most babies will receive an antibiotic that can fight a broad spectrum of bacteria to help combat the infection. Once the tests confirm the type of infection, the medication may be altered.

Your baby may also receive oxygen to help him breathe easier, or he may be placed on a ventilator. Keeping your baby well hydrated and nourished are also top priorities – his body needs nutrients to fight the infection. With all of this treatment, your baby’s lungs can begin to repair themselves.

Can pneumonia be prevented?

A premature baby may develop different infections for the reasons noted above. But the spread of infections can be avoided through the use of proper hygiene. Visitors who come to the NICU should be free from illness (colds, sore throats, coughs). All visitors should wash hands thoroughly or use foam disinfectant before seeing or touching your baby.

Some infections can spread through the air. Having visitors wear a face mask that covers the nose and mouth can provide an added layer of protection for your baby. NICU staff follows strict protocols regarding hand washing and keeping equipment squeaky clean. They are aware of how to prevent the spread of germs.

The good news

Most babies respond well to medications and recover without lasting issues.

With the awareness and news coverage this week of the Kennedy assassination, I fell to thinking about the strength of Jacqueline Kennedy. Not only had she lost her husband but a few months before she had also lost her infant son as a result of premature birth.

Mrs. Kennedy had a history of difficult pregnancies. She had a miscarriage in 1955, followed by a stillbirth in 1956. While Caroline was full term, John Jr. was a preemie and of course, her final child, Patrick died after only living 40 hours from what we now call Respiratory Distress Syndrome. Sadly, this occurred 27 years before the March of Dimes grantees helped develop surfactant therapy, which was introduced in 1990.

Mrs. Kennedy was a heavy smoker and smoked throughout her pregnancies. This was before the US Surgeon General’s warning was known to the public. Although smoking was more common in those years, no one was aware of the repercussions of smoking during pregnancy. Today, it is still a risk factor for stillbirth, low birth weight babies and prematurity. The Great American Smokeout was yesterday; if you do smoke, please consider quitting. Smokefree.gov has tips.

I also want to highlight the possible effects of stress in pregnancy. There are several types of stress that can cause problems during pregnancy. Negative life events, like death in the family, long-lasting stress such as depression and being the wife of the President, could have also played a role.

The loss of any child is difficult; I cannot image the pain she went through. Premature birth can and does happen to any woman.

On average, a developing baby’s lungs are considered to be mature and fully functional around 35 to 36 weeks after conception. For babies born before that, breathing can be a serious challenge. Respiratory distress syndrome (RDS) is the most common illness in the NICU. RDS can be mild or quite severe, but the good news is that 99% of babies with RDS survive. The babies who don’t survive usually are the youngest, smallest babies born before 26 weeks of gestation.

Surfactant is a foamy substance that lines the lungs in mature babies and keeps them from collapsing, making breathing in and out easier. Premature babies lack surfactant and their lungs collapse between breaths. This makes inhaling air and exhaling carbon dioxide very difficult. The energy it takes to expand and contract the lungs can be exhausting and overwhelming for these tiny babies.

Research has shown us that the earlier a baby is born the less surfactant is likely to exist in the lungs and the more likely it is for him to develop RDS. Boys are more likely to get RDS than girls because their lungs mature more slowly. Preemies with mothers who have diabetes or with Rh blood-type incompatibilities are at greater risk for RDS because their lungs are slower to produce surfactant. Babies with mothers who have severe preeclampsia are more vulnerable to RDS because their normal lung development is disrupted. Babies born via cesarean delivery and without labor are at increased risk for RDS. This is because labor produces hormones that promote lung maturation and uterine contractions may help squeeze excess fluid from a baby’s lungs, making breathing easier.

Most babies who will get RDS show symptoms within a few hours of birth. RDS usually gets worse for a couple of days and then improves as the baby starts to produce more surfactant. Treatment includes giving a dose or two of man-made surfactant and providing breathing assistance with oxygen, C-PAP or mechanical ventilation, depending on each baby’s needs.

While the survival rate is extremely high, severe RDS may lead to longer-term health problems. Mechanical ventilation can be life-saving, but it is harsh. Chronic lung disease, also known as bronchopulomonary dysplasia (BPD), comes as a result of inflammation and scaring of the lungs that may result from ventilation. Children with severe RDS also have an increased likelihood of asthma.

We were recently asked about surfactant and how it helps a premature baby’s lungs.

“Surfactant” is a condensed form of the term “surface-active agent,” meaning something that reduces the surface tension of liquids. So what does that really mean? Example: Detergents are surfactants – their lowering of the natural surface tension of water is what keeps bubbles from collapsing, and lets dishwater foam. Mature lungs are foamy organs, largely composed of tiny, bubble-like air sacs that are prevented from collapsing by lung surfactant. This complex mixture of fatty substances and specialized proteins is produced in the lungs, starting many weeks before birth.

Premature babies often lack lung surfactant. The more prematurely a baby is born, the less likely it is to be producing enough surfactant to enable normal lung function. Immature lungs resist inflation and collapse after each exhale. The effort of breathing under these circumstances – called “respiratory distress syndrome,” or RDS – can exhaust a very small, premature newborn and lead to severe complications and even death. Survivors of RDS may have brain damage due, in part, to being unable to get enough air. In recent decades, respiratory treatments have contributed to the improved survival rates for premature babies, but the lungs of some babies have been injured in the process.

Lung surfactant was identified in the 1950s. During the 1980s, many research groups around the world studied surfactant from human amniotic fluid and synthetic varieties. Such studies showed the safety and effectiveness of both rescue treatment (given to babies already developing RDS) and preventive treatment (given to very premature infants before they show signs of RDS.)

The March of Dimes is pleased to have supported early research on lung surfactant for premature infants. Widespread use of surfactant has contributed to a significant drop in deaths from RDS and a drop in the U.S. infant mortality rates. In the past decade, the March of Dimes has invested over $2.6 million in research involving lung surfactant.